Shoulder strength following acromioclavicular injury

Abstract

The acromioclavicular (AC) joint enjoys the dubious distinction of being one of the few joints in the body whose total dislocation is routinely treated by simply leaving the joint dislocated. Adherents of both conservative and operative treatment have presented reasons for their viewpoints. Residual shoulder weakness has been offered as a sequela of untreated acromioclavicular injury and a reason for repairing the joint. An objective evaluation of shoulder strength would be valuable in determining the optimum treatment for this injury. The purpose of our study was to quantitate, using the Cybex II, the residual shoulder weakness following various modes of treatment. Seventeen patients with Grade III AC separations and eight patients with Grade II AC sprains were reviewed. Nine of the Grade III injuries were treated and eight nonoperatively. All Grade II injuries were treated nonsurgically. All patients were tested on the Cybex II isokinetic dynamometer at both slow and fast speeds through various ranges of motion. Grade III injuries treated nonoperatively showed no significant strength deficits. Surgically treated Grade III injuries had a significant strength deficit in vertical abduction at fast speeds (19.8%) when compared to the uninjured shoulder. Interestingly, the Grade II injuries led to a significant weakness in horizontal abduction (24.3%) at fast velocity. Evaluation of subjective results showed that Grade III injuries treated conservatively had the most pain and stiffness, despite their strong shoulders. Patients with Grade III injuries treated operatively rated their overall outcome below that of those treated conservatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Acromioclavicular joint injuries: indications for treatment and treatment options

“…26,92 Functional deficits are minimal, with the objective evaluation of shoulder strength reported to be similar to that of the contralateral shoulder at midterm follow-up. 78,84,87 However, there has been a reported 17% loss of bench press strength. 78 Complaints of persistent AC joint tenderness, instability, shoulder stiffness, and cosmetic deformity may require subsequent surgical intervention.…”

“…78 Complaints of persistent AC joint tenderness, instability, shoulder stiffness, and cosmetic deformity may require subsequent surgical intervention. 87,92 Studies comparing the results of nonoperative and surgical treatment of type III AC separations have shown that surgical intervention does not have a substantial benefit. 3,47,54,68,69,82 In a randomized controlled trial with 4 years of follow-up, Bannister et al 3 compared nonoperative and operative management (with a CC screw) for 42 patients with a type III AC separation and 12 with type V. The patients with type III injuries who were treated nonoperatively obtained full shoulder motion more quickly, returned to work or sport earlier, and had fewer unsatisfactory results than those treated surgically.…”

Acromioclavicular Dislocations Type III

“…This is documented in Table 1. Several studies could not document significant strength differences in patients with complete AC dislocations who were treated conservatively [14][15][16][17] (Sellers et al 1988, personal communication). More recently, Zarzycki et al [18] treated 14 athletes with 2-week immobilization and intensive rehabilitation.…”

Minimally invasive endoscopic reconstruction technique of acute AC-joint dislocations: a cadaver study

“…Their surgical technique was a transarticular K-wire stabilization of the reduced clavicle. Walsh et al [20] showed that patients treated conservatively after type III AC dislocation had no significant strength deficit tested with an isokinetic dynamometer in comparison to the uninjured shoulder. Nevertheless these patients complained of the most pain and stiffness in their subjective evaluation despite their strong shoulders.…”